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Abstract Dengue haemorrhagic fever (DHF) is recognized to have high mortality in patients with chronic kidney disease (CKD) and heart failure (HF). They are at high risk of shock during the ascending limb of the critical phase of DHF, fluid overload during convalescence and bleeding throughout the entire illness. Physiological changes and medications used in CKD/HF make the diagnosis and monitoring of DHF difficult. Treatment with standard fluid regimens also poses a challenge due to the propensity for fluid overload. As a result, standard dengue guidelines do not provide recommendations on fluid management regimens in DHF with CKD/HF. This article provides a narrative review on the existing evidence for management of DHF in patients with volume-changed states such as HF, CKD and nephrotic/ nephritic syndromes. It will explore the relevant diagnostic and therapeutic dilemmas, acknowledge the challenges for developing guidelines and recommend strategies to improve fluid management in these groups of patients.

Dengue haemorrhagic fever (DHF) is recognized to have high mortality in patients with chronic kidney disease (CKD) and heart failure (HF). They are at high risk of shock during the ascending limb of the critical phase of DHF, fluid overload during convalescence and bleeding throughout the entire illness. Physiological changes and medications used in CKD/HF make the diagnosis and monitoring of DHF difficult. Treatment with standard fluid regimens also poses a challenge due to the propensity for fluid overload. As a result, standard dengue guidelines do not provide recommendations on fluid management regimens in DHF with CKD/HF. This article provides a narrative review on the existing evidence for management of DHF in patients with volume-changed states such as HF, CKD and nephrotic/ nephritic syndromes. It will explore the relevant diagnostic and therapeutic dilemmas, acknowledge the challenges for developing guidelines and recommend strategies to improve fluid management in these groups of patients. [ABSTRACT FROM AUTHOR]

Introduction: Dengue Fever (DF) poses a critical public health threat in tropical regions, displaying a spectrum of manifestations without distinct diagnostic hallmarks. Neutrophil to Lymphocyte Ratio (NLR) and Platelet to Lymphocyte Ratio (PLR) are useful biomarkers of inflammation and prognostic markers in various diseases. The inflammation that occurs in dengue is due to the exaggerated response of the immune system. Aim: To assess the utility value of NLR and PLR as prognostic markers for dengue severity. Materials and Methods: A cross-sectional study was conducted on 99 admitted Dengue patients. Patients were grouped into three categories: DF, Dengue Haemorrhagic Fever (DHF), and Dengue Shock Syndrome (DSS). Various parameters of Complete Blood Count (CBC), NLR, and PLR were compared among the groups using Analysis of Variance (ANOVA) test (p-value

Introduction: Dengue Fever (DF) poses a critical public health threat in tropical regions, displaying a spectrum of manifestations without distinct diagnostic hallmarks. Neutrophil to Lymphocyte Ratio (NLR) and Platelet to Lymphocyte Ratio (PLR) are useful biomarkers of inflammation and prognostic markers in various diseases. The inflammation that occurs in dengue is due to the exaggerated response of the immune system. Aim: To assess the utility value of NLR and PLR as prognostic markers for dengue severity. Materials and Methods: A cross-sectional study was conducted on 99 admitted Dengue patients. Patients were grouped into three categories: DF, Dengue Haemorrhagic Fever (DHF), and Dengue Shock Syndrome (DSS). Various parameters of Complete Blood Count (CBC), NLR, and PLR were compared among the groups using Analysis of Variance (ANOVA) test (p-value <0.05 considered significant). Sensitivity, specificity, and accuracy were calculated using Receiver Operating Characteristic (ROC) curve. Results: Among the 99 patients, 63.6% exhibited thrombocytopenia (platelet count <1.5 lac/dL), and 7% of patients had a platelet count <20,000/dL. All DHF and DSS patients had thrombocytopenia. Leucopenia was evident in 45.45% of patients, with 6% having a Total Leukocyte Count (TLC) <2000/dL. TLC remained stable across these stages. The mean NLR in DF was 2.47 (range 0.1-15.4), in DHF it was 1.013 (range 0.2-3.2), and in DSS it was 0.41 (range 0.08-0.65.17) with a p-value of 0.02. The PLR displayed substantial differences, with mean values of 134.4 (range 10.1-273.8) for DF, 50.57 (range 7.1-96.1) for DHF, and 10.39 (range 3.1-38.8) for DSS with a p-value of 0.003. NLR had 63% accuracy, 77.8% sensitivity, and 94.4% specificity. PLR had 81.5% accuracy, 93.3% sensitivity and 33.3% specificity. Conclusion: The specificity of NLR was higher, while PLR exhibited superior accuracy and sensitivity in detecting severe cases. [ABSTRACT FROM AUTHOR]

Background: Dengue is the most common arboviral infection that spreads by Aedes aegypti and Aedes albopictus mosquitoes, and is quickly gaining prominence as a major mosquito-borne viral disease. One of the major public health issues is dengue fever (DF), which can also cause dengue haemorrhagic fever (DHF) and dengue shock syndrome (DSS). Therefore, this study focused on comparison of dengue antigen non-structural protein (NS1) and immunoglobulin M (IgM) using enzyme-linked immunosorbent assay (ELISA) and immunochromatography test (ICT) for detection of dengue. Method: In a Tertiary Care Hospital (TCH), sociodemographic status of probable dengue cases from February 2021 to February 2022 was studied. The results of the Dengue Antigen NS1 and IgM ICT, Dengue NS1 Microlisa, and Dengue IgM Microlisa were compared in order to determine the effective one at managing patients and preventing complications like DHF and DSS. Results: In distribution of 100 ICT reactive samples, 50% were NS1 reactive and 50% were IgM reactive. One hundred ICT reactive samples were further processed for IgM antibody capture enzyme-linked immunosorbent assay (MAC-ELISA) for both NS1 and IgM. Sensitivity and specificity of NS1 ICT were 89.3% and 71.4% and that of IgM ICT was 88% and 64.5%. As a result of antigenic cross-reactivity, false positive cases were reported. Platelet count of the patients was correlated with an optical density (OD) value of ELISA for both NS1 and IgM. In the present study, patients having low platelet count showed high OD value. Conclusion: In cases of severe thrombocytopenia (platelet count <50000), early diagnosis by screening ICT and confirmation by ELISA (NS1 and IgM) would reduce the complications like DHF and DSS. [ABSTRACT FROM AUTHOR]

Background Judicious fluid resuscitation and stringent monitoring of clinical parameters improve the outcome of dengue haemorrhagic fever (DHF). The usefulness of serum lactate to monitor adequate fluid therapy has not been adequately explored. Methods An observational study was conducted in Sri Lanka, recruiting 162 DHF patients within 12 h of diagnosis of the critical phase. Venous lactate level was measured at each time of performing haematocrit (HCT), using a prevalidated handheld lactate analyser. Results The median venous lactate level was 1.3 (range 0.3–6) mmol/L in the study population and 154 (95.2%) patients had median lactate levels of <2 mmol/L. The HCT values in the study participants ranged from 28 to 62, with a median value of 43. There was no statistically significant correlation between the lactate and HCT values obtained at the same time. A significant reduction in venous lactate was not observed following the administration of fluid boluses. The expected reduction in HCT was seen following the administration of dextran and crystalloid/dextran combination. The maximum recorded lactate level positively correlated with the duration of hospital stay. Conclusions This study concludes that venous lactate is not an appropriate parameter with which to monitor the response to fluid therapy in uncomplicated DHF. [ABSTRACT FROM AUTHOR]

Dengue fever is one of the most common tropical disease affecting humans. Symptomatic dengue infection causes a wide range of clinical manifestations from mild dengue fever to potentially fatal disease such as DHF or DSS. Menorrhagia is rarely presented as a symptom in females with DHF. It is often unnoticed in adolescents who has history of irregular menstruation especially in case of PCOS. This case discusses about an adolescent girl who presented with heavy menstrual bleeding, reddish discolouration of urine, severe abdominal pain, generalised body ache, mild head ache, nausea and fever along with a history of irregular menstruation. Dengue fever along with covid-19 was suspected due to the presentation and the patient revealed a travel history to relative's house. Ayurvedic medicines were administered according to patient's condition. The disease was confirmed as Dengue Haemorrhagic fever by Dengue IgM antibody, Dengue IgG Antibody, NS1 Ag and low platelet count, along with negative RT-PCR for Covid-19. This case serves as a valuable case study in DHF, which can be overlooked by Gynaecologists due to its co-presentation with menstruation, especially in patients with a history of irregular menstruation due to PCOS. Further more this case demonstrates the efficacy of simple, cost effective Ayurvedic interventions, which can be successfully utilized in fatal diseases like DHF with proper monitoring and follow up.

Background: DENV (dengue viral infection) is a non-hepatotropic RNA virus, but hepatic involvement is common. High level of viremia is associated with involvement liver and other organs. Present study is a prospective study which is aimed to know about the, pattern of hepatic involvement in dengue patients. Methods: This is a prospective hospital-based study conducted in the Department of General Medicine of tertiary care hospital of central India. During study period 200 clinically and serologically positive patients of Dengue fever, Dengue haemorrhagic fever and Dengue shock syndrome, classified as per the, definition of national vector borne disease control programme Govt. of India. Results: The mean value of total bilirubin was found to be 0.8 mg/dl in patients with dengue fever (DF), 0.96 mg/dl in patients with dengue hemorrhagic fever (DHF), and 1.08 mg/dl in patients with dengue shock syndrome (DSS). The mean value of aspartate aminotransferase (AST) was 77.44 IU/L in the dengue fever (DF) group, 112.32 IU/L in the dengue hemorrhagic fever (DHF) group, and 486.28 IU/L in the dengue shock syndrome (DSS) group. The average alanine aminotransferase (ALT) level in the DF group was 94.36 IU/L, while in the DHF group it was 386.42 IU/L. The average serum albumin levels were found to be 3.97 gm/dl in the DF group, 3.65 gm/dl in the DHF group, and 3.49 gm/dl in the DSS group. The average serum globulin levels were 2.98 mg/dl in the DF group, 2.86 gm/dl in the DHF group, and 2.69 gm/dl in the DSS group. The serum alkaline phosphate level exhibited an elevation in all groups under investigation. The mean value of ALP was found to be 118.46 IU/L in the DF group, 164.32 IU/L in the DHF group, and 342.42 IU/L in the DSS group. Conclusion: The pattern of hepatic involvement of liver in dengue fever varies as per the severity of disease. In milder case of dengue fever liver function test was normal but there was hepatomegaly was present commonly but in severe form of disease pattern of hepatic involvement varies from tender hepatomegaly to significant increase in liver enzyme. [ABSTRACT FROM AUTHOR]

Dengue fever is a mosquito-borne disease caused by flavivirus. It primarily infects people living in tropical and subtropical areas and can be transmitted vertically or horizontally to new-borns. We discuss the clinical spectrum, treatment, and outcomes of five neonates who presented with dengue fever at Aga Khan Hospital for Women in Karimabad, Karachi, Pakistan, during the 2021 post-monsoon season (October to December). Dengue infection was confirmed via positive NS1 antigen test. All new-borns had fever, flushing, and thrombocytopenia. Capillary leak syndrome and haemorrhagic complications occurred in one case. Two babies required oxygen support, with one mortality. Due to the severity of the disease in this population, we suggest that dengue fever should be evaluated as a differential diagnosis in neonates with sepsis and thrombocytopenia, especially in high-risk or endemic areas. ---Continue

Abstract Background Dengue haemorrhagic fever is a severe form of acute dengue infection characterized by leakage of plasma through capillaries into body spaces resulting in circulatory insufficiency leading to shock. Despite varying degrees of liver involvement occurring in acute dengue infection, intrahepatic cholestasis is very rare in the literature with only two cases reported so far. We report a challenging case of a middle-aged woman with DHF complicated by acute liver failure, coagulopathy, acute renal failure and prolonged intrahepatic cholestasis. She was successfully managed in the intensive care unit with supportive therapy, Cytosorb® and therapeutic plasma exchange. Case presentation A 54-year-old Sri Lankan obese woman with multiple comorbidities presented with fever, headache, vomiting and generalized malaise for 3 days and was diagnosed with dengue haemorrhagic fever. Despite the standard dengue management, she clinically deteriorated due to development of complications such as, acute liver injury, intrahepatic cholestasis and acute renal injury. Acute liver failure was evidenced by transaminitis, lactic acidosis, coagulopathy with pervaginal bleeding and severe encephalopathy necessitating elective intubation and mechanical ventilation. She was immediately transferred to intensive care facilities where she underwent supportive management for liver failure, continuous renal replacement therapy coupled with cytosorb and therapeutic plasma exchange with which she made a remarkable recovery. Conclusion Acute liver failure with a prolonged phase of intrahepatic cholestasis is a very rare complication of acute dengue illness which is sparsely documented in medical literature so far. This patient was managed successfully with supportive therapy, aided by cytoSorb hemo-adsorption and therapeutic plasma exchange.

Dengue fever is one of the most frequent arboviral diseases in the world. Dengue is known to cause myocarditis, hepatitis, and neurological illustrations but one of the established presentations is leakage of plasma resulting in circulatory failure. Spontaneous rupture of the spleen is one of the most infrequent but known outcome of dengue fever which has been reported from time to time in literature. We present, here, the case of a 50-year-old patient who developed this condition during dengue fever and was managed in our department successfully. This complication must be kept in mind while treating any case of dengue fever so that it can be avoided or if not then treated timely. Keywords: Spontaneous splenic rupture, Dengue Fever, Dengue haemorrhagic fever, Haemoperitoneum.

Background: Dengue haemorrhagic fever is a severe form of acute dengue infection characterized by leakage of plasma through capillaries into body spaces resulting in circulatory insufficiency leading to shock. Despite varying degrees of liver involvement occurring in acute dengue infection, intrahepatic cholestasis is very rare in the literature with only two cases reported so far. We report a challenging case of a middle-aged woman with DHF complicated by acute liver failure, coagulopathy, acute renal failure and prolonged intrahepatic cholestasis. She was successfully managed in the intensive care unit with supportive therapy, Cytosorb® and therapeutic plasma exchange. Case presentation: A 54-year-old Sri Lankan obese woman with multiple comorbidities presented with fever, headache, vomiting and generalized malaise for 3 days and was diagnosed with dengue haemorrhagic fever. Despite the standard dengue management, she clinically deteriorated due to development of complications such as, acute liver injury, intrahepatic cholestasis and acute renal injury. Acute liver failure was evidenced by transaminitis, lactic acidosis, coagulopathy with pervaginal bleeding and severe encephalopathy necessitating elective intubation and mechanical ventilation. She was immediately transferred to intensive care facilities where she underwent supportive management for liver failure, continuous renal replacement therapy coupled with cytosorb and therapeutic plasma exchange with which she made a remarkable recovery. Conclusion: Acute liver failure with a prolonged phase of intrahepatic cholestasis is a very rare complication of acute dengue illness which is sparsely documented in medical literature so far. This patient was managed successfully with supportive therapy, aided by cytoSorb hemo-adsorption and therapeutic plasma exchange. [ABSTRACT FROM AUTHOR]

Dengue virus (DENV) was discovered by P. M. Ashburn and Charles F. Craig in 1907. Evidence of dengue-like illness was observed before 1907 and DENV epidemics have been reported from different parts of the world since then, with increased morbidity rates every year. DENV typically causes a febrile illness that ranges from mild asymptomatic infection to fatal dengue haemorrhagic fever (DHF) and/or dengue shock syndrome (DSS). Host mechanisms through which mild infection progresses to the fatal forms are still unknown. Few factors have been associated to aid severe disease acquisition, DENV non-structural 1 (NS1) protein being one of them. NS1 is a highly conserved glycoprotein among the Flavivirus and is often used as a biomarker for dengue diagnosis. This review focuses on assessing the role of NS1 in severe dengue. In this review, hospital-based studies on the association of dengue NS1 with severe dengue from all over the world have been assessed and analysed and the majority of the studies positively correlate high NS1 levels with DHF/DSS acquisition. The review also discusses a few experimental studies on NS1 that have shown it contributes to dengue pathogenesis. This review assesses the role of NS1 and disease severity from hospital-based studies and aims to provide better insights on the kinetics and dynamics of DENV infection with respect to NS1 for a better understanding of the role of NS1 in dengue. [ABSTRACT FROM AUTHOR]

Dengue hemorrhagic fever (DHF) is a health problem in Indonesia that tends to show an increase in the number of sufferers and distribution areas. There are various obstacles to reducing the number of DHF sufferers, including the lack of public knowledge about dengue transmission and knowledge to prevent dengue infection. Based on the Health Office of Kalideres Sub-district, West Jakarta, there were 480 cases of dengue fever during January-December 2015; in Kalideres Subdistrict, West Jakarta, there were 60 patients. This study aims to determine the level of education and knowledge of the community regarding dengue prevention behavior in Kalideres District, West Jakarta. The research was conducted on the community in Kalideres Subdistrict, West Jakarta in October-November 2016 using a cross sectional study design. Sampling was 100 respondents using random sampling technique. The instrument used was a questionnaire with data analysis using the Chi-square test. Based on 100 samples, 55.0% of respondents had good knowledge and respondents with poor knowledge were 35.0%, respondents with high education were 78.0% and respondents with low education were 22.0%, respondents who took good precautions were 63.0% while respondents who took less prevention were 37.0%. The results of bivariate analysis showed a significant relationship between the variable level of education and preventive behavior (p=0.008), and there was a significant relationship between the variable level of knowledge and preventive behavior. Through counseling as an effort to provide knowledge for the community, it is hoped that public awareness and a better understanding of dengue fever can be achieved. [ABSTRACT FROM AUTHOR]

Dengue is a viral disease that primarily affects tropical and subtropical regions and is especially prevalent in South-East Asia. This mosquito-borne disease sometimes triggers nationwide epidemics, which results in a large number of fatalities. The development of Dengue Haemorrhagic Fever (DHF) is where most cases occur, and a large portion of them are detected among children under the age of ten, with severe conditions often progressing to a critical state known as Dengue Shock Syndrome (DSS). In this study, we analysed two separate datasets from two different countries– Vietnam and Bangladesh, which we referred as VDengu and BDengue, respectively. For the VDengu dataset, as it was structured, supervised learning models were effective for predictive analysis, among which, the decision tree classifier XGBoost in particular produced the best outcome. Furthermore, Shapley Additive Explanation (SHAP) was used over the XGBoost model to assess the significance of individual attributes of the dataset. Among the significant attributes, we applied the SHAP dependence plot to identify the range for each attribute against the number of DHF or DSS cases. In parallel, the dataset from Bangladesh was unstructured; therefore, we applied an unsupervised learning technique, i.e., hierarchical clustering, to find clusters of vital blood components of the patients according to their complete blood count reports. The clusters were further analysed to find the attributes in the dataset that led to DSS or DHF. [ABSTRACT FROM AUTHOR]

Rationale: Dengue fever is a viral infection that is spread through the bites of infected female Aedes mosquitos. It can cause life threatening complications, including dengue haemorrhagic fever (DHF) and dengue shock syndrome. Patient concerns: A 15-year-old male presented with fever and petechiae and later developed hemoptysis. Diagnosis: Dengue fever with DHF with diffuse alveolar hemorrhage. Interventions: Invasive ventilation with high positive end expiratory pressure, multiple transfusions of packed red blood cells, fresh frozen plasma, single donor platelets and inotropic support. Outcomes: The patient was stabilized and discharged on minimal supplemental oxygen. Lessons: Diffuse alveolar hemorrhage, although very rare, should be considered in a patient with dengue who presents with hemoptysis. The treatment is directed at providing respiratory and circulatory support, and preventing the progression of microcirculation damage. [ABSTRACT FROM AUTHOR]

Abstract Background Dengue fever prevalence is rising globally and it causes significant morbidity and mortality. Fluid extravasation during the critical phase of dengue haemorrhagic fever (DHF) leads to shock, multi-organ failure and death if not resuscitated appropriately with fluids. The mainstay of management is judicious fluid replacement using a guideline based, calculated fluid quota of maintenance (M) fluid plus 5% deficit (M + 5% deficit) to prevent organ hypoperfusion. Methods We conducted an observational follow-up study in Sri Lanka from January–July 2017 to identify the fluid requirements of DHF patients and to identify whether features of fluid overload are present in patients who exceeded the fluid quota. Patients who developed DHF following admission to the place of study, were recruited and the amount of fluid received during the critical phase was documented. Results A total of 115 DHF patients with a mean age of 30.3 (SD 12.2) years were recruited to the study. There were 65 (56.5%) males and the mean fluid requirement was 5279.7 ml (SD 735) over the 48 h. Majority of the study participants (n = 80, 69.6%) received fluid in excess of the recommended maintenance + 5% deficit and this group had higher body mass index (22.75 vs 20.76, p0.03) and a lower white cell count at the onset of the critical phase (3.22 × 103 vs 4.78 × 103, p

Dengue is an arboviral infection that is hyperendemic in tropical and subtropical climates. Clinical manifestations of dengue can range from asymptomatic infection to severe infection with multi-organ failure. Dengue haemorrhagic fever (DHF) is a subcategory in dengue infection with a hallmark of plasma leak (ie critical phase). The plasma leak in DHF is selective (pleuroperitoneal spaces), transient and dynamic, and needs careful monitoring and meticulous fluid resuscitation. In addition, dengue fever may present with extended and unusual manifestations affecting any organ, including the heart, liver, kidney and brain. Studies on vaccine development and vector control are ongoing to prevent this infection of global importance. In this article, the clinicopathological features and management aspects of dengue are discussed. [ABSTRACT FROM AUTHOR]

Background: Dengue hemorrhagic fever (DHF) has been occurring in Indonesia for more than 50 years, and there were 65,602 cases of it in 2018 alone. Sumenep District reported the 12th highest number of DHF cases (292) in East Java Province in 2018. Purpose: This research aims to describe DHF in Sumenep District in 2018. Methods: This research is a descriptive study employing a cross-sectional design. The data used in this research were secondary data gathered from the Sumenep Health Office in 2018. The variables observed in this research were the epidemiological characteristics included in the epidemiological triangle—people, place (region), and time. Descriptive analysis was conducted to examine the DHF case distribution, using a frequency table, among the people, place (region), and time variables. Results: Sumenep District is home to 1,085,227 citizens, with a population density of 518 people/km2. The number of DHF cases in Sumenep District was 292, with the highest concentration of cases in the age range of 5–14 years (47.30%); the most cases were also male (57.19%). DHF often occurred in sub-districts with high population density, and more commonly in January. Conclusion: Most of the Sumenep District’s DHF cases in 2018 were males in the age group of 5–14 years old.

Dengue fever is one of the most common tropical disease affecting humans. Symptomatic dengue infection causes a wide range of clinical manifestations from mild dengue fever to potentially fatal disease such as DHF or DSS. Menorrhagia is rarely presented as a symptom in females with DHF. It is often unnoticed in adolescents who has history of irregular menstruation especially in case of PCOS. This case discusses about an adolescent girl who presented with heavy menstrual bleeding, reddish discolouration of urine, severe abdominal pain, generalised body ache, mild head ache, nausea and fever along with a history of irregular menstruation. Dengue fever along with covid-19 was suspected due to the presentation and the patient revealed a travel history to relative's house. Ayurvedic medicines were administered according to patient's condition. The disease was confirmed as Dengue Haemorrhagic fever by Dengue IgM antibody, Dengue IgG Antibody, NS1 Ag and low platelet count, along with negative RT-PCR for Covid-19. This case serves as a valuable case study in DHF, which can be overlooked by Gynaecologists due to its co-presentation with menstruation, especially in patients with a history of irregular menstruation due to PCOS. Further more this case demonstrates the efficacy of simple, cost effective Ayurvedic interventions, which can be successfully utilized in fatal diseases like DHF with proper monitoring and follow up., Competing Interests: Conflict of interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Dengue is a viral disease that primarily affects tropical and subtropical regions and is especially prevalent in South-East Asia. This mosquito-borne disease sometimes triggers nationwide epidemics, which results in a large number of fatalities. The development of Dengue Haemorrhagic Fever (DHF) is where most cases occur, and a large portion of them are detected among children under the age of ten, with severe conditions often progressing to a critical state known as Dengue Shock Syndrome (DSS). In this study, we analysed two separate datasets from two different countries– Vietnam and Bangladesh, which we referred as VDengu and BDengue, respectively. For the VDengu dataset, as it was structured, supervised learning models were effective for predictive analysis, among which, the decision tree classifier XGBoost in particular produced the best outcome. Furthermore, Shapley Additive Explanation (SHAP) was used over the XGBoost model to assess the significance of individual attributes of the dataset. Among the significant attributes, we applied the SHAP dependence plot to identify the range for each attribute against the number of DHF or DSS cases. In parallel, the dataset from Bangladesh was unstructured; therefore, we applied an unsupervised learning technique, i.e., hierarchical clustering, to find clusters of vital blood components of the patients according to their complete blood count reports. The clusters were further analysed to find the attributes in the dataset that led to DSS or DHF.

Pathogens associated with haemorrhagic fever commonly have zoonotic origins. The first documented imported case of likely viral severe haemorrhagic fever in Sweden occurred in 1990. Despite extensive study, no aetiological agent was identified. Following retrospective investigation with total RNA-sequencing of samples collected between 7 and 36 days from onset of symptoms we identified dengue virus 3 (DENV-3) and a human pegivirus (HPgV). We conclude that the patient likely suffered from haemorrhagic symptoms due to an atypical severe and undiagnosed dengue infection.

Introduction: Dengue has rapidly emerged as a vector - borne viral disease in recent years and also endemic in all continents. The agent of dengue, i.e., dengue viruses, are categorised under the genus Flavivirus, with the four dengue virus serotypes: designated as DENV-1, DENV-2, DENV-3 and DENV-4. These all four serotypes are in circulation either singly, or more than one at the same time. Aim: To study the epidemiological update of dengue with circulating serotype and co-infection in Saurashtra region, Gujarat, India. Materials and Methods: A cross-sectional study was conducted during January 2019 to December 2020 and total samples received were 12,563 which were clinically suspected dengue samples case. After receiving blood samples, serum was separated and proceeded for Dengue NS1Ag (nonstructural protein 1 antigen), and Dengue IgM Ab (Immunoglobulin M antibody). After serological confirmation, 151 samples from different geographical area were selected for Dengue specific Reverse Transcriptase- Polymerase Chain Reaction (RT-PCR) for serotyping. results: Total 4069 (32%) had confirmed dengue positive by Enzyme Linked Immunosorbent Assay (ELISA). The ratio of male cases was higher than female, and in age group 21-35 year (47%). Seasonal trend showed a gradual increase in positivity from June with high peak in October. Circulation of all the four serotypes in area, higher monotypic infection by DENV-1 serotype (41%), followed by DENV-4, DENV-2 and DENV-3. Coinfection of different serotypes were also found. conclusion: The present study concluded that all four serotypes circulate with predominant being DENV-1 type and co-infection of different serotypes in the saurashtra region. Dengue mainly affected adult male population, and seasonal peak during monsoon and post-monsoon period. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study is to find out the frequency and pattern of skin manifestations of dengue fever. Methods: This study was carried out in the department of Medicine & Allied, HBS General Hospital, Islamabad, from August 2019 till October 2019. Total 70 patients were included in the study. All the patients had a clinical diagnosis of Dengue fever which was confirmed by dengue NS1 antigen test. Demographic data, presenting complaints and examination findings were noted for all the study patients. All the information was recorded on a specially designed proforma. Data was analyzed using computer program SPSS version 21. Results: Out of 70 patients; 46 were males (66%) & 24 were females (34%). Mean age of the patients was 36 years. DF and DHF were found in 74% and 26% respectively. None of the patients had DSS. Among the presenting features, high grade fever, headache, sore throat, myalgias and vomiting were common. Cutaneous features were observed in 61% of the cases. Most frequent finding was conjunctival congestion, seen in 60% of the cases. Other findings included: oral mucosa congestion 58%, maculopapular rash 48%, localized itching 28%, generalized itching 26%, petechiae 22%, gingival bleeding 7%, ecchymosis 4% and epistaxis 4%. Conclusion: This study highlights the presence of dermatological manifestations in dengue fever which could aid as a clue to diagnosis. [ABSTRACT FROM AUTHOR]

Abstract Background Series of biochemical and haematological changes occur during the course of dengue infection, which vary depending on the clinical disease. The patterns of change are not well documented and identifying these patterns in children with dengue infection would help to anticipate the progression to different clinical stages thus enabling effective management. Methods A prospective follow up study was conducted during the period of July 2013 – April 2014 at Professorial Pediatric unit, Lady Ridgeway Hospital for Children, Colombo, Sri Lanka. Children (5–12 years) admitted within the first 84 h of fever, with a clinical diagnosis of dengue infection were recruited. Children who became positive for dengue IgM were included in the final analysis. Blood was collected on admission for complete blood count, Alanine aminotransferase, Aspartate aminotransferase, albumin, cholesterol and corrected calcium. These tests were repeated at 12 hourly intervals during the hospital stay. Results Data of 130-subjects were analyzed (Dengue fever /Dengue hemorrhagic fever: 100/30). There was a significant difference in the pattern of white cell counts, platelets and haematocrit in the two clinical groups. Both transaminase rose initially in both dengue fever and dengue hemorrhagic fever and a steep rise were seen between 8th and 9th days in hemorrhagic fever. Both albumin and cholesterol decreased significantly at the time of entering into the critical phase. According to Receiver operating characteristic curve analysis, albumin level crossing 37.5g/L (sensitivity 86.7%, specificity 77.8%) and a 0.38 mmol/L reduction in cholesterol level (sensitivity 77.3%, specificity 71.9%) between day 3 and 4 were the best predictors of entering into critical phase. Calcium levels did not show any distinct pattern. Conclusions There is a clear difference in the pattern of change of both hematological and biochemical parameters in dengue fever and dengue hemorrhagic fever. Reduction in albumin and cholesterol levels seen between the completion of day 3 and day 4 were highly valid predictors of entering into critical phase in dengue hemorrhagic fever.

ABSTRACTDengue fever is one of those unique diseases where host immune responses largely determine the pathogenesis and its severity. Earlier studies have established the fact that dengue virus (DENV) infection causes haemorrhagic fever and shock syndrome, but it is not directly responsible for exhibiting these clinical symptoms. It is noteworthy that clinically, vascular leakage syndrome does not develop for several days after infection despite a robust innate immune response that elicits the production of proinflammatory and proangiogenic cytokines. The onset of hyperpermeability in severe cases of dengue disease takes place around the time of defervescence and after clearance of viraemia. Extracellular vesicles are known to carry biological information (mRNA, miRNA, transcription factors) from their cells of origin and have emerged as a significant vehicle for horizontal transfer of stress signals. In dengue virus infection, the relevance of exosomes can be instrumental since the majority of the immune responses in severe dengue involve heavy secretion and circulation of pro-inflammatory cytokines and chemokines. Here, we present an updated review which will address the unique and puzzling features of hyperpermeability associated with DENV infection with a special focus on the role of secreted extracellular vesicles.

Background: Dengue viruses, single-stranded positive polarity ribonucleic acid (RNA) viruses of the family Flaviviridae, are the most common cause of arboviral disease in the world and has turned this disease into a serious public health problem. Aims: To study retrospectively the incidence of laboratory confirmed dengue cases among the clinically suspected patients, the clinical profile of dengue-positive cases, and to co-relate with the environmental conditions. Materials and Methods: Five hundred and eighty blood sample was collected in the microbiology laboratory of district hospital Singtam, from clinically suspected cases of dengue infection, from 22nd August 2013 till 30th November 2013 for rapid dengue kit test initially followed by confirmation test by Immunoglobulin M (IgM) capture ELISA test. Conclusions: Fever with myalgia should be evaluated for Dengue fever (DF) in Sikkim, northeastern part of India. We also report the first outbreak of dengue fever in the east district (Singtam) of Sikkim.

Background: Dengue hemorrhagic fever (DHF) still become a serious health problem in Indonesia where the number of cases reported in 2015 was 129,650 incidence with total mortality of 1,071 persons. Blitar city is the region which considered as the 13th highest dengue fever cases in East Java Province. Purpose: This study aims to describe the dengue fever cases in Blitar City. Methods: This study is a descriptive observational study with a case series approach. The data used in this study is dengue fever data in the East Java Health Profile from 2015 to 2017. Results: The majority of dengue fever occurred in the age group 5-14 years (46.72%), and the most cases of dengue fever occur in men (51.19%). The Blitar City is considered as one of the areas with high cases of dengue fever every year with the Incidence Rate (IR) in 2016 reaching 189 per 100,000 persons. However, the data showed that the cases promotion of dengue fever were not in line with the increase in rainfall in Blitar City. Jumantik consists of 166 persons that spread across 21 regions, but the larvae free index from Blitar City is still low counting about 79% of 95%. Conclusion: Blitar City is an endemic area of DHF that has stratification of 20 hamlets. The pattern of dengue fever in Blitar City from 2015 to 2017 was the highest in men and the age group of 5-14 years.

The advantage of a chest X-ray in the RLD position in 15 children with DHF hospitalized at the paediatric ward of the Ternate General Hospital within the period of May-June-July 1990 and June-July 1991 were evaluated. Besides clinical and laboratory assessment to establish the diagnosis of DHF according to the WHO guidelines (1975), child and a haemaglutination-inhibition test was also done to confirm the diagnosis. Chest X-rays in the RLD position found a pleural effusion in 11 out of 15 patients with DHF especially in those with dengue shock syndrome. A positive serological test was always associated with the presence of PE (100%), while this could be shown in only 2 patients with negative test results. It may be concluded that the WHO criteria for the clinical diagnosis of DHF may be confirmed not only by the serological test but also by the presence of PE on chest film in the RLD position and therefore this examination may play an important role in establishing a diagnosis of DHF in a regency hospital.

Introduction: Dengue fever or infection is a potentially fatal infection that can occur in people of all age groups. Dengue virus is distributed worldwide and represents a serious public health problem; it affects over 100 million people worldwide, annually. Detection of Non-structural Protein 1 (NS1) antigen helps in diagnosing dengue infection in the early stages and helps in prevention of Dengue Shock Syndrome (DSS) and Dengue Haemorrhagic Fever (DHF). Aim: To identify the dengue specific antigen (NS1) and antibody (Immunoglobulin M (IgM) and Immunoglobulin G (IgG)) and correlate them with the platelet and White Blood Cell or Total Leukocyte Count (WBC or TLC) and also to assess the effectiveness of platelet transfusion in these patients. Materials and Methods: This was a prospective study done for two consecutive years involving only second half of the year 2018 and 2019 i.e., June-December 2018 and June-December 2019. Dengue infection or fever incidence is more during second half of the year during monsoon and winter seasons. A total of 587 samples were included in this study (positives) out of 4477 samples received for dengue testing. Statistical analysis was done with the help of SPSS version 14.0 software. A p-value

Background: Dengue fever prevalence is rising globally and it causes significant morbidity and mortality. Fluid extravasation during the critical phase of dengue haemorrhagic fever (DHF) leads to shock, multi-organ failure and death if not resuscitated appropriately with fluids. The mainstay of management is judicious fluid replacement using a guideline based, calculated fluid quota of maintenance (M) fluid plus 5% deficit (M +  5% deficit) to prevent organ hypoperfusion.Methods: We conducted an observational follow-up study in Sri Lanka from January-July 2017 to identify the fluid requirements of DHF patients and to identify whether features of fluid overload are present in patients who exceeded the fluid quota. Patients who developed DHF following admission to the place of study, were recruited and the amount of fluid received during the critical phase was documented.Results: A total of 115 DHF patients with a mean age of 30.3 (SD 12.2) years were recruited to the study. There were 65 (56.5%) males and the mean fluid requirement was 5279.7 ml (SD 735) over the 48 h. Majority of the study participants (n = 80, 69.6%) received fluid in excess of the recommended maintenance + 5% deficit and this group had higher body mass index (22.75 vs 20.76, p0.03) and a lower white cell count at the onset of the critical phase (3.22 × 103 vs 4.78 × 103, p < 0.001). The highest fluid requirement was seen within the first 12 and 24 h of the critical phase in patients requiring fluid M +  5%-7.5% deficit and ≥ M +  7.5% deficit respectively. Patients exceeding M + 5% deficit had narrow pulse pressure and hypotension compared to the rest. DHF grades III and IV were seen exclusively in patients exceeding the fluid quota indicating higher amount of fluid was given for resuscitation. Fluid overload was detected in 14 (12.1%) patients and diuretic therapy was required in 6 (5.2%) patients.Conclusions: The majority of patients received fluid in excess of the recommended quota and this group represents patients with narrow pulse pressure and hypotension. Although, fluid overload was infrequent in the study population, clinicians should be cautious when administering fluid in excess of M +  7.5% deficit. [ABSTRACT FROM AUTHOR]

Dengue Fever (DF) is a self-limiting mosquito transmitted disease characterised by fever, headache, muscle pain, joint pain, rash, nausea and vomiting. Dengue Haemorrhagic Fever (DHF) is a severe and more serious form of DF, characterised by fever, bleeding manifestations, plasma leakage and thrombocytopenia. This is a report of a 32-year-old male, presented with history of fever and myalgia with two episodes of vomiting and presence of petechial rash. Patient was diagnosed with DHF. The patient presented with absent breath sounds on respiratory examination and his chest radiograph (posteroanterior view) showed right-sided pleural effusion. Pleurocentesis revealed haemorrhagic fluid in the absence of trauma. Unprovoked haemothorax as an initial presentation of DHF is a rare occurrence.

Neurological problems are more frequently linked to dengue, a mosquito-transmitted virus common in tropical areas. This review study thoroughly examines the effects of dengue on adult males' neurological systems. Dengue hemorrhagic fever (DHF) or dengue shock syndrome (DSS) can develop in severe cases of dengue fever caused by the dengue virus (DENV). Unsettlingly, it is thought that a sizable portion of DENV infections impact the central nervous system (CNS), which calls into question the former theory that the DENV is not neurotropic. This review dissects the many neurological manifestations of dengue, spanning from encephalopathy, encephalitis, and other CNS implications to peripheral neuromuscular issues, through the systematic analysis of publications gathered from PubMed. The essay emphasizes the immunological reactions brought on by DENV infections and offers a deeper understanding of the pathophysiology. Given that they exhibit similar first symptoms, Zika and chikungunya are two more illnesses that must be distinguished from dengue. The mainstay of current diagnostic methods is serum and cerebrospinal fluid (CSF) tests, although supportive care is still used. This review highlights the importance of tracking neurological symptoms in dengue patients and encourages more studies in this area., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Kakde et al.)

Abstract Objective This retrospective study was conducted in 2017 with the objective of evaluating the value of acute phase peripheral blood parameters in predicting dengue haemorrhagic fever (DHF). Patients, who were admitted to Teaching Hospital Peradeniya between January and August 2017 due to dengue illness, were recruited into this study. Results A total of 515 patients participated in the study. Among them, 333 were DHF patients while 182 patients were managed as DF. There was a significant difference in mean values of platelets and haemoglobin observed during acute phase in non-leakers compared to the patients who progressed to DHF, while no significant difference was observed for white blood cells, neutrophils, lymphocytes and haematocrit values. A significantly higher mean value was observed in white blood cells and hemoglobin in leakers compared to non-leakers during day 5. Mean day 5 platelet value was significantly lower among leakers compared to non-leakers but no significant difference between haematocrit, neutrophil and lymphocyte values were observed. ROC curve performed for acute phase platelet values and haemoglobin values to gain a predictive value for female and male DHF patients and cut off values with high sensitivity and specificity to predict DHF could be obtained for the platelet count.

Latar belakang: Demam berdarah Dengue (DBD)merupakan masalah kesehatan di Indonesia yang sampai saat ini cenderung menunjukkan peningkatan dalam jumlah penderita maupun daerah persebaran. Terdapat berbagai kendala untuk menurunkan jumlah penderita DBD, diantaranya kurangnya pengetahuan masyarakat tentang penularan DBD serta pengetahuan untuk mencegah infeksi DBD. Berdasarkan Dinas Kesehatan Kabupaten Karawang tercatat kasus Demam Berdarah Dengue selama Januari - Desember 2015 mencapai 480 kasus DBD; di Desa Kemiri Kabupaten Karawang sebanyak 60 penderita. Tujuan: Penelitian ini bertujuan untuk mengetahui tingkat pendidikan dan pengetahuan masyarakat mengenai perilaku pencegahan DBD di Desa Kemiri. Metode: Penelitian dilakukan terhadap masyarakat di desa Kemiri pada bulan Oktober - November tahun 2016 dengan menggunakan desain studi crosssectional. Pengambilan sampel sebanyak 100 responden dengan teknik random sampling. Instrumen yang digunakan adalah kuesioner dengan analisis data menggunakan uji Chi-square. Hasil: Berdasarkan 100 sampel didapatkan 55,0% responden memiliki pengetahuan baik dan responden dengan pengetahuan kurang sebanyak 35,0%, responden dengan pendidikan tinggi sebanyak 78,0% dan responden dengan pendidikan rendah sebanyak 22,0%, responden yang melakukan tindakan pencegahan baik sebanyak 63,0% sedangkan responden yang melakukan pencegahan kurang sebanyak 37,0%. Hasil analisis bivariat menunjukkan hubungan yang signifikan antara variabel tingkat pendidikan dengan perilaku pencegahan (p=0,008), dan terdapat hubungan yang signifikan antara variabel tingkat pengetahuan dengan perilaku pencegahan. Simpulan: Melalui penyuluhan sebagai upaya pembekalan pengetahuan bagi masyarakat diharapkan kepedulian masyarakat serta pemahaman yang lebih baik tentang DBD. Background: Dengue Haemorrhagic Fever has been a health problem in Indonesia until recently, thus, tend to show an increase in the number of patients and the spread area. Various difficulties still blocking the way to bring down the amount of morbidities; public ignorance regarding dengue fever caused lack of awareness in the prevention of dengue fever itself. Based on Dinas Kesehatan Kabupaten Karawang, the DHF morbidities showed 480 people from Januari to Desember 2015, and Desa Kemiri data were 60 people infected. Objective: This study aimed correlation of education level and knowledge of people or occupants in Desa Kemiri, Kertajaya, Karawang regardless of DHF prevention. Methods: This study held on Oktober to November 2016 based on cross-sectional study. All 100 respondents were occupants of Desa Kemiri, with randomized sampling system. Questionnaires were given as instruments and then analized by Chi–square. Result:The results showed that out of 100 respondents, 55% were having good knowledge of DHF, and 35% were not; 78% respondents were well educated, while 22% were not; 63% respondents showed good DHF prevention, and 37% were not. There were also significancy results showed by bivariate data analysis between variable of education level and prevention of DHF (p=0.08), along with variable of knowledge level and prevention of DHF. Conclusion: The awareness and aknowledgement of DHF can be well achieved through public presentation as a simple way to make people understood about the DHF.

Background: Dengue haemorrhagic fever (DHF) is a major problem in public health of the world and in tropical area especially Africa and South-East Asia. An endemic area of DHF in Thailand has begun since 1949. DHF in Khon Kaen province increased and transmitted into all areas. This study examined the spatiotemporal pattern of DHF incidence in Khon Kaen during 2008-2017. Method: DHF data were obtained from Bereau of Vector Borne Disease, Khon Kaen province during 2008 – 2017 were geo-code at sub-district level. The data were acquired a space-time with elevated proportions of DHF incidence rate. The spatio-temporal technique analysis were conducted for a DHF transmission. Result: The DHF outbreak in Khon Kaen province, Thailand were decrease in every year but DHF was shifted from urban areas to rural areas. The spatial clustering analysis were identified the risk areas in the district that closed Nakhon Ratchasima province and shifted to Udon Thani province in 2015. Conclusion: The DHF clustered map is one of the best measurement for identified a risk area for surveillance. It has been an effectiveness prevention and controlling plan and allocated a resources of DHF. [ABSTRACT FROM AUTHOR]

Background: In dengue infection, knowing time to platelet recovery is essential for optimal management. Aims: To determine a predictor for platelet recovery in patients with dengue infection. Methods: Platelet count and immature platelet fraction (IPF) from daily blood samples of patients with dengue infection during hospitalisation and 1–4 weeks after discharge were retrospectively analysed. The levels of patients' IPF were compared with normal controls recruited from healthy children with normal platelet counts. Results: A total of 244 EDTA blood samples were collected daily from 64 patients (45 males) with dengue infection (36 dengue fever, 28 dengue haemorrhagic fever) during hospitalisation and after discharge from the hospital. They did not receive any platelet concentrate transfusion. The median IPF among normal children was 3.6% with a 95 percentile of 9.9%. In dengue patients, an IPF of ≥10.0% after defervescence was associated with a subsequent platelet count of ≥60 × 109/L within 72 hours. Conclusion: In patients with dengue infection, IPF ≥10.0% after defervescence is a predictor of subsequent platelet recovery to a haemostatic level ≥60 × 109/L within 72 hours. [ABSTRACT FROM AUTHOR]

Introduction: Dengue infection inflicted a huge burden towards health problem in tropical and subtropical countries. Reported cases were more than 1.2 million in 2008, which increased to over 3.2 million in 2015, involving the Americas, South-East Asia, and Western Pacific regions. Published studies regarding predictors of severe dengue have been inconsistent and therefore accurate methods to predict severe dengue is needed. This review was performed to synthesise from the relevant studies regarding predictors of severe dengue Methodology: A systematic literature search was performed using PubMed, ScienceDirect, and Google Scholar for articles published from 2015 until 2019. The search was based on the inclusion criteria and keywords, including 'predictors', 'factors associated', 'severe dengue' and 'dengue haemorrhagic fever' and 'dengue shock syndrome'. The inclusion criteria were all observational studies with full articles and written in English. Reviewed articles, systematic review and meta-analysis articles were excluded. Study on children and solely involved biomolecular components were also excluded. Unpublished literature was not searched in this review. Result: After multistage screening conducted based on inclusion and exclusion criteria, 9 out of 1312 initially searched articles, were assessed and reviewed in the final stage. The significant predictors were reported to increase risk of severe dengue significantly includes sociodemographic (age), medical history (secondary infection, pre-existing comorbid), clinical presentation (warning signs, fluid accumulation, bleeding tendency, low blood pressure), laboratory profile (increase haematocrit, low platelet count, raised ALT, raised lactate), secondary dengue infection and as well as the delayed hospitalisation and late seeking treatment. Conclusion: In conclusion, older age group, presence of comorbid and the number of comorbid, secondary infections, presence of warning signs, abnormal haematocrit rise and platelet count drop, were independent risk factors of severe dengue. These factors may be useful to guide triage at the presentation of adult dengue patients who are at higher risk of severe dengue. [ABSTRACT FROM AUTHOR]

Background Evidence indicates that socio-economic status (SES) may affect health outcomes in patients with chronic diseases. However, little is known about the impact of SES on the prognosis of acute dengue. This nationwide cohort study determined the risk of dengue haemorrhagic fever (DHF) in Taiwanese dengue fever patients from 2000 to 2014. Methods From 1 January 2000, we identified adult dengue cases reported in the Taiwan Centers for Disease Control Notifiable Diseases Surveillance System Database. Dengue cases were defined as positive virus isolation, nucleic acid amplification tests or serological tests. Associations between SES and incident DHF were estimated using a Cox proportional hazards model. Results Of 27 750 dengue patients, 985 (3.5%) had incident DHF during the follow-up period, including 442 (4.8%) and 543 (2.9%) with low and high SES, respectively. After adjusting for age, sex, history of dengue fever and comorbidities, low SES was significantly associated with an increased risk of incident DHF (adjusted hazard ratio [AHR] 1.61 [95% confidence interval {CI} 1.42 to 1.83]). Rural-dwelling dengue patients had a higher likelihood of DHF complication than their urban counterparts (AHR 2.18 [95% CI 1.90 to 2.51]). Conclusions This study suggests low SES is an independent risk factor for DHF. Future dengue control programs should particularly target dengue patients with low SES for improved outcomes. [ABSTRACT FROM AUTHOR]

Background: Dengue infection is a deadly global pandemic due to its fatal nature, being emerged from mild stage to turn into more severe stages and consequently causing casualties. it upsurges various phases, namely subclinical infection, undifferentiated febrile fever, Dengue fever (DF) and devastating states which often ends to life, they are Dengue haemorrhagic fever (DHF) and Dengue shock syndrome (DSS). Dengue infection is a mosquito born disease which has engulfed many regions in general and tropical zone in particular, causing many casualties and has posed a threat to humanity, demanding strategies to resolve the global issue. It is reported that 50-200 million people fall prey to it globally by dint of its causative agents and imperative to mention that over proportional are the minor among the victims. Because of awful joint pain dengue fever is also named break bone fever. The common indicator in infected individuals is thrombocytopenia, coagulopathy and vasculopathy. Apart from supportive therapy, no aphoristic therapy has been introduced so far, however care may prove rescuer. Timely prognosis thwarts to enter it in deteriorating phase. Methods: In the list of laboratory diagnosis virus serology and detection of Ribonucleic acid are primed. In general, there's no specific decisive diagnostic biomarker present through which accurate and prompt prognosis can possible during the entire patient presentation time, particularly in case of secondary dengue infection. Although, through the advancement and commercialization of point-care combined tests, capable of tracking disease markers present during various phases of infection (viral non-structural protein 1 and immunoglobulin M), such evaluation massively improved the treatment through lab-based. Conclusion: Despite such improvements, major hurdles persist in the clinical management of patients with dengue infection, particularly lack of dependable biomarkers that have an efficacious prognostic gauge to predict steady progress to severe disease. In the described review both clinical and laboratory diagnosis of dengue infection has been highlighted, including concern regarding future accessibility. [ABSTRACT FROM AUTHOR]

Dengue virus is estimated to cause over 100 million infections throughout the world annually. Although dengue infections can have a wide range of clinical pictures, atypical manifestations have been described recent years. The liver is a susceptible organ affected in dengue infection. Mild liver dysfunction is common in cases of dengue infection but severe liver function impairment and even encephalopathy are rare. The following is a case report of dengue hemorrhagic fever (DHF) with acute fulminant hepatitis. A 43-year-old woman has fulminant hepatitis on day 3 of treatment. Her AST level increased dramatically from 363 U/L to 3,246 U/L. The causes of other hepatitis infection has been excluded. Her dengue IgM-antibody level was reactive. Level of dengue IgM antibody reactive. Clinical improvement experienced by patient after supportive therapy and administration glisirizin or Stronger Neo-Minophagen-C (SNMC).

Density Figure Located in Gianyar Regency, Banjar Menak was experiencing in dengue cases. Dengue Haemorrhagic Fever (DHF) is one of the top ten most frequent inpatient disease in Gianyar, with incidence of 442,3 in 100.000 people (2015). The mosquito larva surveillance and mosquito nest eradication had not been wellimplemented in the area, there for, we conducted a comunity involvement program with the aim to increase the knowledge and the skill of the resident on dengue and its eradication measures. The method of the program was cadre trainning on knowledge of dengue, mosquito larvae surveillance, and mosquito net eradication program. (known as PSN). This trainning was participated by three cadre and three dasawisma of Banjar Menak. The pre-test on the knowledge of the participantis was 71,7% while the post-test was 88%. The participants were not well euiped with understanding on dengue, larvae surveillance, and PSN as it shown on FGD analysis. The weekly post program observation showed a decreasing trend on Container Index (CI) for all the participants’s surveillance area. The CI of week 1 and 4 for each participantss were 9,1 to 1,8; 10,9 to 1,8; 14,6 to 0; 10,9 to 3,6; 49,1 to 3,6; and 20,2 to 1,8. In general, the CI and Density Figure (DF) in Banjar Menak has decreased.The program has achieved its external indicator and deemed as success. The trained cadre and dasawisma is expecting to be the front runner for the community involvement in dengue eradication program in Banjar Menak.

Abstract Background Incidence of dengue fever as well as dengue hemorrhagic fever is increasing in Sri Lanka especially among elderly population. As the number of cases is rising, rare complications of dengue illness also can be seen in clinical practice when compared to the past few years. Prompt identification and treatment of such complications is challenging due to lack of awareness and unavailability of standard treatment. Case presentation 69 years old man presented with acute onset fever and was diagnosed as having dengue illness. On the 4th day of illness, the disease was progressed into dengue haemorrhagic fever and recovered uneventfully. Although he recovered from primary illness, his general condition continued to deteriorate due to new onset of features of parkinsonism. Cerebrospinal fluid analysis and electro encephalogram showed evidence of encephalitis. Cerebrospinal fluid analysis also revealed positive IgM antibodies against dengue virus. Then the diagnosis of post encephalitic parkinsonism following dengue viral infection was made and started on. He was started on SINEMET (carbidopa 10 mg and levodopa 100 mg) half tablet 6 hourly started. After 1 week of treatment he showed marked improvement and then patient was discharged with further follow up plan. Conclusion Although the management of dengue illness and dengue haemorrhagic fever is straightforward, recognition and treatment of rare complications like post encephalitic parkinsonism following dengue viral infection is difficult without great clinical suspicion.

Background Dengue hemorrhagic fever (DHF) infection causes hepatocelullar impairment. In management of DHF, World Health Organization (WHO) recommends the crystalloids Ringer’s acetate (RA) or Ringer’s lactate (RL), which are similar in composition to plasma. Acetate in RA is not metabolized in the liver, hence not burdening the liver, whereas lactate in RL is metabolized mostly in the liver, thus placing a burden on the liver. Objective To compare aminotransferase changes as markers of hepatocellular impairment subsequent to the use of RA and RL in the management of DHF with and without shock. Methods This study was a double-blind randomized controlled trial on DHF patients aged 1-18 years in Cipto Mangunkusumo Hospital who had not received prior treatment with crystalloids or colloids. Subjects were randomly assigned to receive either RA or RL intravenously. Aminotransferase levels were examined on the first, second and third weeks from the onset of fever. Results Ninety-two patients who fulfilled inclusion criteria were enrolled in this study, consisting of those without and with shock. Mean transaminase levels of patients without shock in the RA and RL groups did not differ significantly. Mean transaminase levels of patients with shock in the RA group were lower than those in the RL group, but this difference was not significant statistically. Mean alteration of transaminase levels in patients with and without shock were not significantly different. Conclusion In DHF without shock, there is no significant differ- ence between aminotransferase level changes of patients receiv- ing RA and RL solutions. In DHF with shock, aminotransferase levels of patients receiving RA tend to be lower than those receiv- ing RL, but this difference is insignificant